Is the use of bipolar hemiarthroplasty over monopolar hemiarthroplasty justified? A propensity score-weighted analysis of a multicentre randomized controlled trial.

Using data from the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemiarthroplasty (HEALTH) trial, we sought to determine if a difference in functional outcomes exists between monopolar and bipolar hemiarthroplasty (HA). This study is a secondary analysis of patients aged 50 years or older with a displaced femoral neck fracture who were enrolled in the HEALTH trial and underwent monopolar and bipolar HA. Scores from the Western Ontario and McMaster University Arthritis Index (WOMAC) and 12-Item Short Form Health Survey (SF-12) Physical Component Summary (PCS) and (MCS) were compared between the two HA groups using a propensity score-weighted analysis. Of 746 HAs performed in the HEALTH trial, 404 were bipolar prostheses and 342 were unipolar. After propensity score weighting, adequate balance between the bipolar and unipolar groups was obtained as shown by standardized mean differences less than 0.1 for each covariable. A total of 24 months after HA, the total WOMAC score and its subcomponents showed no statistically significant difference between the unipolar and bipolar groups. Similarly, no statistically significant difference was found in the PCS and MCS scores of the SF-12 questionnaire. In participants aged 70 years and younger, no difference was found in any of the functional outcomes. From the results of this study, the use of bipolar HA over unipolar design does not provide superior functional outcomes at 24 months postoperatively. The theoretical advantage of reduced acetabular wear with bipolar designs does not appear to influence functional outcomes in the first two years postoperatively.

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Déclaration de conflit d'intérêts

The authors report the following, all of which are unrelated to this article: R. W. Poolman reports research support from Lima and Link Orthopaedics, being a board or committee member of the Dutch Orthopaedic Association, and on the dditorial or governing board of My Ortho Evidence. F. Frihagen declares being a paid presenter or speaker for Amgen and Zimmer, and being a board or committee member for AAOS. M. Bhandari reports research support from the Canadian Institutes of Health Research, National Institutes of Health, and US Department of Defense, and being a paid consultant for AgNovos Healthcare, Sanofi-Aventis, and Smith & Nephew, and being a board or committee member for the International Society of Orthopaedic Surgery and Traumatology. S. Sprague declares being an employee of Global Research Solutions and McMaster University, and being on the editorial or governing board of BMC Women's Health. E. Schemitsch discloses being a paid consultant for Acumed, Amgen, Heron Therapeutics, ITS, Pentopharm, Sanofi-Aventis, and Swemac, getting other financial or material support from DePuy, Saunders/Mosby-Elsevier, Stryker, and Zimmer, being a board or committee member of the Canadian Orthopaedic Association, the Orthopaedic Trauma Association, and on the editorial or governing board of the Journal of Orthopaedic Trauma.